Thiazide diuretics contraindications

The thiazide diuretics are contraindicated in patients with known hypersensitivity to the thiazides or related diuretics, electrolyte imbalances, renal decompensation, hepatic coma, or anuria. A cross-sensitivity reaction may occur with the thiazides and sulfonamides. Some of the thiazide diuretics contain tartrazine, which may cause allergic-type reactions or bronchial asthma in individuals sensitive to tartrazine. 

Calcium is contraindicated in patients with hypercalcemia or ventricular fibrillation and in patients taking digitalis. Calcium is used cautiously in patients with cardiac disease. Hypercalcemia may occur when calcium is administered with the thiazide diuretics. When calcium is administered with atenolol there is a decrease in Hie effect of atenolol, possibly resulting in decreased beta blockade. There is an increased risk of digitalis toxicity when digitalis preparations are administered with calcium. The clinical effect of verapamil may be decreased when the drug is administered with calcium. Concurrent ingestion of spinach or cereal may decrease file absorption of calcium supplements. 

Lithium is a drug with a narrow therapeutic index and therefore plasma concentrations are regularly monitored. Lithium is used in the prophylaxis and treatment of mania. Concurrent administration of lithium and diuretics, particularly the thiazides, is contraindicated as lithium excretion is reduced, resulting in increased plasma-lithium concentration and hence toxicity. 

Contraindications Anuria, history of hypersensitivity to sulfonamides or thiazide diuretics, renal decompensation... 

He has previously been prescribed bendroflumethiazide on an escalating dose. This in turn precipitated an episode of gout. At this point the thiazide should have been stopped, since thiazide diuretics are contraindicated in gout. This did not happen. 

In the past, thiazide diuretics have been considered as being contraindicated in pregnancy, because of risks to the mother and fetus. However, more recent evidence suggests that their use need not be contraindicated (35). 

Women receive the same benefits from antihypertensive therapy as men. However, ACE inhibitors and ARBs are contraindicated in women who intend to become pregnant because they are teratogenic. Thiazide diuretics may be especially beneficial in postmenopausal women with osteoporosis because they cause retention of calcium and have been shown to positively affect bone mineral density. Women tend to have higher rates of drug-related adverse effects than men. 

A Mst of thiazides diuretic dmgs is provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more available on the book s Web site (see URL in Appendix). 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Contraindications Hypersensitivitytocarbonicanhydraseinhibitors, local anesthetics, salicylates, sulfonamides, sulfonylureas, sunscreens containing PABA, or thiazide or loop diuretics intestinal or urinary tract obstruction porphyria severe hepatic or renal dysfunction... 

Amiloride is used with thiazide or loop diuretics in hypertension, in congestive heart failure, in digitalis-induced hypokalemia, and in arrhythmias resulting from hypokalemia. Inappropriate use of amiloride may cause hyperkalemia (potassium >5.5 mEq/L), which may be fatal if not corrected, and may be more deleterious in elderly individuals and in patients with diabetes mellitus and renal impairment. The symptoms of hyperkalemia include fatigue, flaccid paralysis of the extremities, paresthesias, bradycardia, ECG abnormalities, and shock. Amiloride is not metabolized but is contraindicated in anuria, acute or chronic renal insufficiency, or in diabetic nephropathy. It should not be used with potassium preparations, and should be used cautiously with ACE inhibitors because these agents cause hyperkalemia. 

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